A recent article in Anesthesiology News titled ‘Incorrectly Recorded Anesthesia Start Times Cause Major Revenue Loss’ recaps a study presented at the American Society of Anesthesiologists’ ADVANCE 2023 event. The study was conducted at a university medical center in Chicago and asserts that anesthesia providers are not capturing all their time because over 68% of the time the anesthesia start time was when the patient entered the operating room without including the preparation time.
At a cursory glance, we can understand how this appears to be shorting anesthesia time. However, from a compliance perspective, we must look at the regulations for starting anesthesia time. CMS defines anesthesia start time as when the anesthesia practitioner begins to prepare the patient for anesthesia services in the operating room or an equivalent area. In the Illinois Medicaid Handbook for Practitioners Rendering Medical Services, in sections A-221.1 and A-221.2, anesthesia start time is not to include the preoperative anesthesia consultation and only include the time period spent in the operating room, beginning with the anesthesiologist preparing for induction of anesthesia. Additionally, the National Correct Coding Initiative (NCCI) Chapter 2, section B.6, provides several examples of services considered integral to the anesthesia service and are accounted for in the base units of the procedure rather than including time for these services. Although not an all-encompassing list, some of the examples include routine transport of the patient, placing IVs, and many others.
There are always exceptions, like transporting and monitoring a patient from ICU to the operating room. These should be documented in the electronic anesthesia record to properly support an anesthesia start time prior to being in the operating room. Additionally, a few state Medicaid programs have slightly different definitions for anesthesia start time, allowing the time to start with the administration of an anesthetic agent.
Contrary to the study findings, if you are starting your anesthesia time when the patient enters the operating room, you are not losing significant revenue.
The HANK/ACE Team